Widening our Focus: Characterizing Socioeconomic and Racial Disparities in Congenital Heart Disease

Ann Thorac Surg. 2021 Apr 16:S0003-4975(21)00700-1. doi: 10.1016/j.athoracsur.2021.04.008. Online ahead of print.


BACKGROUND: Socioeconomic and racial (SER) disparities among congenital heart disease (CHD) patients may limit access to high-quality care. We characterized national SER landscape, its relationship to early outcomes, and identified interactions among determinants mitigating adverse outcome.

METHODS: The Pediatric Health Information System (PHIS) database queried patients (age < 26 years) with CHD between 2016-2018. ICD-10 codes were mapped to diagnostic categories for complexity adjustment. Correlational and hierarchical regression analyses identified risk-factors and characterized interactions.

RESULTS: N=166,599 unique admissions from 52 hospitals were identified, 58,395 having interventions. Median age was 0 years (IQR=4 years). Race/Ethnicity was predominantly White (59%), Hispanic (20%), and Black (16%). Median neighborhood household income (NHI) was $41,082, and varied among hospitals. Patient NHI had a parabolic relationship with mortality, with both higher and lower values having increased risk. Black patients had significantly higher mortality, and this relationship was potentiated by lower NHI and complexity. Length of hospital stay (LOS) was longer among Black neonates (median 51 days; IQR 93) compared to neonates of other ethnic groups (median 32 days; IQR 71), P<0.0001. Care pathways including permanent feeding tubes were also more prevalent among Black neonates (17.8%) compared to White neonates (15%), P=0.02.

CONCLUSIONS: Interactions among SER disparities modify CHD outcomes. Specific hospitals have more SER fragile patients, but may have developed care pathways that prolong LOS to mitigate risk among Black neonates. Adverse outcomes among SER disadvantaged patients are magnified in complex CHD, suggesting tangible benefits to targeted resource allocation and population health initiatives.

PMID:33872577 | DOI:10.1016/j.athoracsur.2021.04.008